Clinical investigations
Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: Comparison with the Allen's test in 1010 patients

https://doi.org/10.1016/j.ahj.2003.10.038Get rights and content

Abstract

Background

To avoid ischemic hand complications, the percutaneous transradial approach is only performed in patients with patent hand collateral arteries, which is usually evaluated with the modified Allen's test (MAT). This qualitative test measures the time needed for maximal palmar blush after release of the ulnar artery compression with occlusive pressure of the radial artery. The objectives were to evaluate the patency of the hand collateral arteries and to compare MAT with combined plethysmography (PL) and pulse oximetry (OX) tests before the percutaneous transradial approach.

Methods

Patients referred to the catheterization laboratory were prospectively examined with MAT, PL, and OX tests. PL readings during radial artery compression were divided into 4 types: A, no damping; B, slight damping of pulse tracing; C, loss followed by recovery; or D, no recovery of pulse tracing within 2 minutes. OX results were either positive or negative. Results of both tests were compared in 1010 consecutive patients.

Results

MAT results ≤9 seconds on either hand were seen in 93.7% of patients. PL and OX types A, B, or C on either hand were seen in 98.5% of patients. On the basis of the MAT ≤9 seconds criteria, 6.3% of patients were excluded from the transradial approach, whereas with PL and OX types A, B, and C, only 1.5% of patients were excluded. There was more exclusion in men and with increasing age by using both methods.

Conclusions

In the evaluation of hand collaterals, PL and OX were found to be more sensitive than MAT. When applied to transradial approach screening, only 1.5% of patients were not suitable candidates for the transradial approach.

Section snippets

Methods

From June 1999 to January 2000, consecutive unselected patients referred to the catheterization laboratory for coronary angiography or intervention were prospectively examined for patency of the ulnopalmar arterial arch with the MAT and PL and OX of both the right and left side by 1 of the investigators (G.R.B., F.A., L.D.). The reproducibility of the tests was randomly verified and considered to be excellent.

Results

Of the 1010 consecutive patients, 32% were women, 19% had diabetes mellitus that was treated with oral hypoglycemic drugs or subcutaneous insulin, and 7% had undergone previous coronary artery bypass graft surgery. The mean patient age was 62 ± 11.2 years (range [r], 22–88 years), with a mean weight and height of 76.4 ± 15.6 kg (r, 36–160 kg) and 1.7 ± 0.1 m (r, 1.0–1.9 m), respectively.

Discussion

We have described and compared 2 techniques for evaluating the presence of functional palmar arterial arch before a tansradial approach. Our results clearly show that the use of PL and OX criteria type A, B, or C in any side was more sensitive and could include more patients than MAT result ≤9 seconds, while being more objective.

Acknowledgements

We thank Dr Paul Poirier and Gilles R. Dagenais (Institut de cardiologie de Québec), for their help in reviewing the manuscript.

References (40)

  • L. Campeau

    Percutaneous radial artery approach for coronary angiography

    Cathet Cardiovasc Diagn

    (1989)
  • P.R. Stella et al.

    Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty

    Cathet Cardiovasc Diagn

    (1997)
  • H.A. Saaman

    The hazards of radial artery pressure monitoring

    J Cardiovasc Surg

    (1971)
  • R.F. Bedford et al.

    Complications of percutaneous radial-artery cannulationan objective prospective study in man

    Anaesthesiology

    (1973)
  • R.J. Baker et al.

    Severe ischemia of the hand following radial artery catheterization

    Surgery

    (1976)
  • R. Wilkins

    Radial artery cannulation and ischaemic damagea review

    Anaesthesia

    (1985)
  • E. Benit et al.

    Frequency of a positive modified Allen's test in 1,000 consecutive patients undergoing cardiac catheterization

    Cathet Cardiovasc Diagn

    (1996)
  • B. Ejrup et al.

    Clinical evaluation of blood flow to the handthe false-positive Allen test

    Circulation

    (1966)
  • D.E. Greenhow

    Incorrect performance of Allen's test—ulnar artery flow erroneously presumed inadequate

    Anaesthesiology

    (1972)
  • M. Hirai et al.

    False positive and negative results in Allen test

    J Cardiovasc Surg

    (1980)
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